BUSINESS LOAN APPLICATION

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1 BUSINESS LOAN APPLICATION One Commerce Park P. O. Box 160 Shallowater,Texas Phone Fax ADDRESS - Page 9 of 23

2 Commercial Loan Application: INFORMATION CONCERNING OWNER(S) AND GUARANTOR(S) Business Name: Business Physical Address: Business Mailing Address: Type of Business: Date of Organization: Years in Business: Business Tax I. D. Number: Business Phone Number: Main Contact: Phone Cell Phone Main Contact Address: Are you applying as a: Corporation ( x) Sole Proprietorship ( x ) Partnership ( x ) Limited Liability Company (LLC) Page 2 of 23

3 Please list below information on all individuals involved in signing or serving as a guarantor for the business: Name Address City, State, Zip Address Cell Phone Name Address City, State, Zip Address Cell Phone Name Address City, State, Zip Address Cell Phone Name Address City, State, Zip Address Cell Phone Page 3 of 23

4 Have any of the above individuals ever declared bankruptcy? YES NO Do you use a Certified Public Accountant or Bookkeeper? YES NO If Yes, please give company, individual contact name and address: Phone Number for accountant: Accountant s Purpose of your loan request _ Loan Amount Requested Down Payment Amount Collateral: Desired Length of Term: Desired Monthly Payment Amount Are there any debts not listed on the financial statements for which your business is obligated? YES NO If yes, what is the total liability? $ _ Is your business party to any claim or lawsuit? YES NO If yes, please describe nature and amount of suit Have you ever owned or operated a business which declared bankruptcy? Does your business owe any IRS taxes or ad valorem taxes for years prior to the current year? YES NO If you answered yes to any of these questions, please provide the details on an attachment. Page 4 of 23

5 I/We certify that all of the above statements made are true and complete and are made for the purpose of obtaining credit from First State Bank, Shallowater, Texas (FSB) for the amount and purpose as stated. I/We authorize FSBto make any credit, employment or investigative inquiry that FSB determines appropriate for the extension of credit or the collection of amount owed to FSB. FSB may furnish information concerning my account to consumer reporting agencies and others who may properly receive that information. If I/We ask, I/We will be informed whether or not a consumer report (credit report) was obtained; and if a report was obtained, I/We will be informed of the name and address of the consumer reporting agency that furnished the report. NOTICE OF INSURANCE U If checked, property insurance is also required in connection with this loan if collateral is required. I may obtain property insurance coverage through the agency or from the insurance company of my choice, The policy must name FSB as loss payee and must be replacement cost coverage for the lesser of the insurable value of the collateral or the principal of the loan. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. To comply with this requirement, please complete the following information prior to opening your account. Applicant Signatures: Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Page 5 of 23

6 Commercial Loan Application Checklist We are providing you with a checklist of documents we are required to obtain to process your loan application. This checklist will help speed up your loan process. If Applicant is an LLC, PARTNERSHIP OR CORPORATION: Please provide the following: NOT COMPLETE APPLICABLE (X) (X) Commercial Loan Application (Enclosed) Consumer Loan Application on all individuals and/or loan guarantors Financial Statement Corporate - Dated and Signed Financial Statements Personal - Dated and Signed Tax Returns (Last 3 yrs) Corporate Tax Returns (Last 3 yrs) Personal Corporate Resolution, Partnership and/or LLC organizational documents Articles of Incorporation Corporate Bylaws Total shares issued and outstanding LLC Agreement Please list the shareholders of the corporation, partnership or LLC: Name Number of shares owned Percentage owned % Name Number of shares owned Percentage owned % Name Number of shares owned Percentage owned % Name Number of shares owned Percentage owned % Page 6 of 23

7 Please list all of the officers of the Corporation or members of the LLC: Name Name Name Name Name Name List of Officers or Members from above that are authorized to sign and obtain loans on behalf of the corporation or LLC. How many signers are required?. List names below: List Officers above are authorized to sign and open depository accounts on behalf of the corporation. How many signers are required to write checks? _ Page 7 of 23

8 Collateral Checklist Please provide and attach the following information based on the collateral and security that you plan to use to secure your loan: 1. Real Estate: 1. Legal Description of the real estate (Copy of Deed) 2. Any Real Estate Appraisal 3. Photographs 4. Copy of real estate sales contract signed by both seller and purchaser if purchasing real estate. 5. Property Survey if available 6. Property Appraisal if available 2. Furniture, Fixtures, Equipment, Inventory: 1. List and valuation of items to be purchased 2. List and valuation of items already owned 3. Location of items 4. Make,Model and serial numbers on items valued over $1,000 if applicable 3. Vehicles, Trailers, Boats and other d Vehicles 1. Make, Model and Vehicle I. D. Numbers on those already owned or to be purchased. 2. Copies of existing vehicle titles, if applicable. 3. Copy of Dealer s Buyer s Order (Deal Sheet) if purchasing new vehicle Page 8 of 23

9 Page 1 of 23

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11 Texas Department of Banking INSTRUCTIONS FOR COMPLETING FINANCIAL INFORMATION Financial statements must be submitted by all proposed directors, executive officers, and principal shareholders. A principal shareholder is defined in Section (a)(44) of the Texas Finance Code. Supporting schedules to the balance sheet should be attached when necessary to itemize or clarify summarized data. Care should be taken to insure that the dates and total amounts shown on the supporting schedules correspond to those on the balance sheet. Supporting schedules are included for real estate and related loans and for proprietary interest; please insert additional pages for other schedules. Describe the method by which real estate market values were determined. If investment securities are shown as an asset and if those securities represent 25% or more of an individual's net worth, financial and cash flow statements of the company for the last two years must be provided, unless the company is publicly traded on a national exchange. The cash flow statement should disclose in a separate line item the payments that will be required to service any loans to finance the purchase of stock. Please complete section on (1) of the enclosed Confirmation Inquiry form which authorizes any financial institution, brokerage firm, or any other entity in which you may have an account to confirm the balance or market value of securities held in said account as of a certain date. If you have accounts at more than one institution, please complete the appropriate number of forms. After completing section one (1) of this Confirmation Inquiry form, it should be submitted to the Department of Banking along with the other forms contained in this packet. Do not send directly to the confirming institution. The form must be signed by all persons who have ownership interest in the account, for example, husband and wife. Otherwise, the confirming institution may return the form in blank, which may result in a delay in processing. Please provide account and loan numbers on the form. Completion of this form is not necessary for interim bank applications. The Department of Banking may require the submission of any other information, including real estate appraisals, that it considers necessary to determine financial capability /1 [Rev. 4 5/05] Texas Department of Banking Page 11 of 23

12 PERSONAL FINANCIAL STATEMENT Name Statement of Financial Condition as of, ASSETS LIABILITIES AND NET WORTH Cash on Hand & in Banks (Schedule 1) $ Notes Payable to Banks-Secured & Unsecured (Schedule 7) $ U.S. Government Securities Notes Payable to Relatives (Schedule 7) Accounts, Loans, & Notes Receivable (Sch 2) Accounts & Notes Payable to Others (Schedule 7) Marketable Stocks & Bonds (Schedule 3)* Rents & Interest Due Real Estate (Schedule 4) Real Estate Taxes Due (Schedule 4) Automobiles - Number ( ) Liens on Real Estate (Schedule 4) Proprietary Interests (Schedule 5) ** Other Assets (Itemize) *** Other Taxes Due Other Liabilities (Itemize) LIABILITIES NET WORTH ASSETS $ LIABILITIES AND NET WORTH $ ANNUAL INCOME CONTINGENT LIABILITIES Salary $ As Endorser or Co-Maker $ Bonus & Commissions Dividends & Interest Real Estate Income Other Income (Itemize) On Leases or Contracts Legal Claims Provision for Federal Income Tax Other Special Debt (Itemize) INCOME $ CONTINGENT LIABILITIES $ Assets pledged or hypothecated value at $ are pledged to secure notes or obligations aggregating $. I have additionally endorsed, guaranteed or am contingently liable for debts of others amounting to $ /2 [Rev. 4 5/05] Texas Department of Banking Page 12 of 23

13 SCHEDULES Schedule 1. Banking Relationships. (List all bank accounts) Name of Financial Institution Address Type of Account Account Number Balance Schedule 2. Accounts, Loans, & Notes Receivable. Name and Address of Debtor Date Originated Description or Nature of Debt Description of Security Held Maturity Date Balance Due * Schedule 3. Marketable Stock and Bonds. Face Value Bonds No. Stock Shares Description of Security Registered in Name of Cost Income Received Last Year If Pledged, State to Whom Present Market Value Schedule 4. Real Estate. The legal and equitable title to all the real estate listed in this statement is solely in the name of the signer, except as follows: Description or Street No. Dimensions or Acres Improvements Consist of Mortgage or Liens Due Dates & Payment Amount Unpaid Taxes Year Amt. Cost Present Market Value /4 [Rev. 4 5/05] Texas Department of Banking Page 13 of 23

14 ** PROPRIETARY INTERESTS (Schedule 5) Provide the following information regarding all business enterprises in which you hold a beneficial interest. The term "business enterprise" includes any corporation, association, partnership, business trust, sole proprietorship or other business which shares are not listed on a securities exchange or otherwise regularly traded. Under the heading "Form of Business", state the legal form of the business. Under "Nature of Business and Percentage of Ownership", explain what the business enterprise does and percentage of your ownership interest. Submit year-end financial statements, including profit and loss and cash flow statements, for the last two years for each business interest in which you have an interest equal to 25% or more of your net worth. Nature of Name and Address Legal Form Business and Date Current of Business of Business % of Ownership Acquired Value Total Schedule 7. Notes or Accounts Payable. Name of Lender Lender's Address Due Dates and Payments Security or Collateral Balance Owed /5 [Rev. 4 5/05] Texas Department of Banking Page 14 of 23

15 CASH FLOW STATEMENT (Schedule 6) Name Signature _ (Print or Type) Provide the following information regarding sources and uses of cash during the last two years, the current year, and a projected year. Sources of Cash Current* Projected Salaries, Wages, Commissions, Bonuses, or Other Income from Employment (Net of Deduction) Dividends Interest Royalties Distribution from Cash Received from Individual Business, Partnerships, or Joint Ventures Real Estate Other ** Total Cash Received Uses of Cash Current * Projected Personal Expenses (Management, Rent and Household, Etc. Bank Loan - Principal and Interest Other Loans - Principal and Interest Insurance Payments Income Taxes Not Covered by Withholding Other** Total Cash Outlays Cash Flow Surplus (Deficit) * If current year is reported for less than a full fiscal or annual period, please provide the dates for the period reported. ** Itemize any items amounting to 10% or more of total income on separate page /6 [Rev. 4 5/05] Texas Department of Banking Page 15 of 23

16 I hereby certify under penalty of perjury that the information contained in this confidential financial report, including supplemental schedules, has been carefully examined by me and is correct and complete and further acknowledge that there are no misrepresentation or omissions of material facts. Dated and signed this day of,. (Signature of Affiant) STATE OF TEXAS COUNTY OF Personally appeared before me the above named, personally known to me, who, being duly sworn, deposes and says that he executed the above instrument and that the statements and answers contained therein are true and correct. Subscribed and sworn to before me this day of,. (Notary Public) (Name Typed or Printed) My commission expires In addition to the supplemental schedules one (1) and two (2) included in this packet, you may wish to provide supplementary schedules for other items on this Individual Financial Statement. The Department of Banking reserves the right to request any additional detail supporting the amounts on this statement. * Marketable securities are generally only those which are listed on the NY, American Stock Exchanges and NASDAQ. ** If the stock of a company amounts to 25% or more of an individual's net worth, financial statements, including balance sheet, profit and loss, and cash flow statements of the company must be provided for the past two years. *** If total reflected on this line represents 10% or more of your net worth, a schedule must be provided listing each item separately and providing a complete description, including financial information, if appropriate /3 [Rev. 4 5/05] Texas Department of Banking Page 16 of 23

17 BUSINESS FINANCIAL STATEMENT Name of Business Applicant Prepared By (Position) Limited Liability Company Partnership Corporation Other Statement of Financial Condition as of, 20 for the period, to, (Round to the nearest hundred) ASSETS LIABILITIES AND NET WORTH CURRENT ASSETS: CURRENT LIABILITIES: Cash on Premises $ Accounts Payable (Schedule 6) $ Cash in Banks (Schedule1a) Accrued Interest on Borrowings Certificates of Deposit (Schedule 1b) Notes Payable - Current Portion Stock, Bonds, & Accrued Taxes Other Marketable Assets (Sch. 2) on Real Estate (Schedule 7) Accounts, Loans, & Notes Receivable (Sch. 3) Accrued Taxes, Other (Schedule 7) Advances to Employees Other Current Payables (Itemize) Prepaid Expenses (Schedule 4) Other Current Assets (Itemize) CURRENT LIABILITIES $ CURRENT ASSETS $ LONG-TERM LIABILITIES: Notes Payable (Itemize) $ FIXED ASSETS: Real Estate & Buildings (Schedule 5) $ Less: Accumulated Depreciation Furniture, Equipment & Vehicles Less: Accumulated Depreciation Notes Payable on Real Estate (Schedule 5) Other Long-Term Liabilities (Itemize) Other Fixed Assets (Itemize) Other Long Term Assets (Itemize if over 5% of total) LONG-TERM LIABILITIES $ NET WORTH OR STOCKHOLDERS EQUITY $ (Schedule 8) ASSETS $ LIABILITIES & NET WORTH $ Assets pledged or hypothecated valued at $ are pledged to secure notes or obligations aggregating $. I have additionally endorsed, guaranteed or am contingently liable for debts of others amounting to $ /1 [8/05] Texas Department of Banking Page 2 of 23

18 SCHEDULES Schedule 1a. Cash in Financial Institutions. Name of Financial Institution and Address Account in Name Of Type of Account Account Number Balance Schedule 1b. Certificates of Deposit. Name of Financial Institution and Address Account in Name Of If Pledged, State to Whom Maturity Date Account Number Balance Schedule 2. Stocks, Bonds & Other Marketable Assets. Face Value Bonds No. Stock Shares Description of Security Registered in Name of Cost Income Received Last Year If Pledged, State to Whom Present Market Value Schedule 3. Accounts, Loans & Notes Receivable. Name and Address of Debtor Age of Debt Description or Nature of Debt Description of Security Held Date Payment Expected Amount Owing /2 [8/05] Texas Department of Banking Page 18 of 23

19 Schedule 4. Prepaid Expenses. Type of Prepaid To Whom Paid Expiration Date Original Amount Current Balance Schedule 5. Real Estate & Buildings. Location or Street No. & Description Mortgages or Liens Unpaid Taxes Due Dates & Payment Amount Year Amt. Cost Present Market Value Schedule 6. Accounts Payable. Nature of Account Payable To When Due Amount Due Schedule 7. Accrued Taxes. Type of Tax Payable To When Due Amount Due /3 [8/05] Texas Department of Banking Page 3 of 23

20 Schedule 8. Net Worth or Stockholders Equity. CORPORATIONS Type Amount Common Stock ( Shares) Preferred Stock Additional Paid-In Capital Retained Earnings /4 [8/05] Texas Department of Banking Page 20 of 23

21 STATEMENT OF INCOME AND EXPENSES For The Period, To, INCOME: Other Income (Itemize) INCOME (+) EXPENSES Advertising Cash (Over) Short Depreciation & Amortization Equipment Rental Insurance Interest & Bank Charges Legal, Audit, Bookkeeping Office Supplies Rent Salaries Security & Janitor Taxes & Payroll Utilities & Telephone Vehicle Expense Other Expenses (Itemize) EXPENSES NET OPERATING INCOME (LOSS) (+) OTHER INCOME (EXPENSES) (Itemize) OTHER INCOME (EXPENSES) INCOME BEFORE TAXES INCOME TAXES NET INCOME (LOSS) (+) (-) /5 [8/05] Texas Department of Banking Page 21 of 23

22 CASH FLOW STATEMENT Provide the following information regarding sources and uses of cash during the last two years, the current year, and a projected year. Sources of Cash Current* Projected Sales Dividends Interest Royalties Cash Received from Individual Business, Partnership, or Joint Ventures Real Estate Other** Total Cash Received Uses of Cash Current* Projected Expenses Bank Loan Principal and Interest Others Loans Principal and Interest Other** Total Cash Outlays Cash Flow Surplus (Deficit) *If current year is reported for less than a full fiscal or annual period, please provide the dates for the period reported. **Itemize any items amounting to 10% or more of total income on separate page /6 [8/05] Texas Department of Banking Page 4 of 23

23 I hereby certify under penalty of perjury that the information contained in this confidential financial report, including supplemental schedules, has been carefully examined by me and is correct and compete and further acknowledge that there are no misrepresentation or omissions of material facts. Dated and signed this day of, 20. (Signature) (Typed or Printed Name) () /7 [8/05] Texas Department of Banking Page 5 of 23

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